Patient Financial Advocate

Description

The Patient Financial Advocate (PFA) supports cancer patients by helping patients understand, navigate, and manage the financial aspects of their treatment. This includes verifying insurance, explaining insurance coverage, assisting with billing inquiries, helping patients understand their financial responsibility, plan for out-of-pocket costs, and identifying potential financial assistance programs. The PFA will work closely with patients, their families, healthcare providers, and insurance companies to ensure that patients have the necessary resources to access the care they need while reducing financial burden.

SPECIFIC JOB DUTIES AND RESPONSIBILITIES: Include the following. Other duties or tasks may be requested or assigned by immediate supervisor, his/her designee or management.

1. Verify insurance coverage and educate patients on their insurance plans, including coverage for cancer treatments, copays, deductibles, and out-of-pocket maximums. Identify and communicate coverage gap and its implications.
2. Help patients and families understand their invoices, insurance claims, and statements. Offer payment plans, discounts, or other financial arrangements to patients facing financial challenges.
3. Provide financial counseling to patients and families regarding payment options, financial aid programs, and available resources such as government assistance programs, Medicaid/Medicare, or state and federal resources.
4. Research and identify potential funding opportunities from charitable organizations, non-profit groups, or pharmaceutical assistance programs.
5. Advocate on behalf of patients to secure financial assistance or adjustments to bills when necessary. Act as a liaison between patients and the billing department, resolving any billing issues or discrepancies in a timely manner.
6. Collaborate with physicians, nurses, and other healthcare staff to ensure patients are informed of any financial concerns that may impact their treatment plan and clearly communicate financial obligations prior to the start of care.
7. Assist patients with navigating appeals or grievances related to insurance denials or other financial issues related to their care.
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8. Document and maintain accurate records of all patient interactions, patient financial counseling, any decisions made in the patient's medical records, financial assistance provided. and comply with privacy law and healthcare regulations, including HIPAA.
9. Stay current on healthcare insurance policies, billing codes, and available patient assistance programs.
10. Provide feedback to management on recurring financial issues or challenges faced by patients.

OTHER JOB REQUIREMENTS: Other job requirements as assigned.

SUPERVISORY RESPONSIBILITY: N/A

EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION :

1. High School Diploma or equivalent. Required
2. Associate degree or higher in Healthcare, Business, Accounting, Legal, or comparable. Preferred.
3. Certification as a Patient Financial Advocate (CPFA) or similar designation, preferred

EXPERIENCE, KNOWLEDGE, SKILLS, and ABILITIES :

1. Minimum of 1 year of experience in healthcare billing, patient financial services, or customer service roles, preferred
2. Experience in oncology or cancer care settings is preferred but not required.
3. Strong communication skills, both verbal and written, with the ability to explain complex financial information to patients in an understandable way.
4. Excellent problem-solving and negotiation skills.
5. High level of empathy and ability to work with patients who may be experiencing emotional or financial stress.
6. Ability to work independently, prioritize tasks, and manage time effectively.
7. Proficiency in Microsoft Office Suite and healthcare management software (e.g., Epic, Cerner, or similar).
8. Medical terminology is a plus.

REASONING ABILITY:

1. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
2. Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:

1. Must interact and communicate both verbally and in written form.
2. Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.
3. Must uphold the CARTI values at all times and be willing to assist patients and staff when needed.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

1. While performing the duties of this job, the employee is regularly required to talk or hear.
2. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
3. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment described here is representative of those an employee encounters while performing the essential functions of this job.


This position involves potential exposure to infectious diseases. Team members are offered appropriate vaccinations and safety training.

This position is a Safety Sensitive Position . The essential functions, physical demands, and mental competencies of this job require the employee to maintain the ability to work in a constant state of alertness in a safe manner.